Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis

Silvia Gonella; Valerio Dimonte; Ylenia Arnone; Beatrice Albanesi; Paola Berchialla; Paola Di Giulio; J T van der Steen

doi:10.1016/j.jpainsymman.2023.05.001

Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis

J Pain Symptom Manage. 2023 Sep;66(3):e365-e398. doi: 10.1016/j.jpainsymman.2023.05.001. Epub 2023 May 8.

Authors

Silvia Gonella¹, Valerio Dimonte², Ylenia Arnone², Beatrice Albanesi², Paola Berchialla³, Paola Di Giulio², J T van der Steen⁴

Affiliations

¹ Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino (S.G.), Torino, Italy. Electronic address: silvia.gonella@unito.it.
² Department of Public Health and Pediatrics (B.A., P.DG., V.D., Y.A.), University of Torino, Torino, Italy.
³ Department of Clinical and Biological Sciences (P.B.), University of Torino, Torino, Italy.
⁴ Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care (J.T.S.), Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen. The Netherlands.

PMID: 37164151
DOI: 10.1016/j.jpainsymman.2023.05.001

Abstract

Context: Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement.

Objectives: To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations.

Methods: Systematic review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available.

Results: A total of 4,663 articles were scanned. Eighteen studies were included in the systematic review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients' clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84-2.84; I² 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80-2.91; I² 95%), patient-reported quality (SMD 0.83, 95% CI -1.06 to 2.71; I² 99%), or duration (ROM 1.20, 95% CI 0.95-1.51; I² 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations.

Conclusion: Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.

Keywords: Clinical encounter; conversations; end of life; meta-analysis; systematic review; terminally ill.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Communication
Death
Humans
Terminal Care*